Provider Demographics
NPI:1326021437
Name:LAWRENCE, THOMAS EARL (MD)
Entity Type:Individual
Prefix:
First Name:THOMAS
Middle Name:EARL
Last Name:LAWRENCE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 63112
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28263-3112
Mailing Address - Country:US
Mailing Address - Phone:336-274-9617
Mailing Address - Fax:336-482-2177
Practice Address - Street 1:1331 N ELM ST STE 200
Practice Address - Street 2:
Practice Address - City:GREENSBORO
Practice Address - State:NC
Practice Address - Zip Code:27401-6304
Practice Address - Country:US
Practice Address - Phone:336-274-9617
Practice Address - Fax:336-482-2177
Is Sole Proprietor?:Yes
Enumeration Date:2005-11-22
Last Update Date:2023-05-01
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NC329452085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC1601500OtherUNITED HEALTHCARE
NC51243OtherBLUE CROSS BLUE SHIELD
NC300065899OtherRAILROAD MEDICARE
VA1326021437Medicaid
NC18334OtherPARTNERS
NC70513OtherMEDCOST
NC8951243Medicaid
NCE84700Medicare UPIN
VA1326021437Medicaid